Please note: An erratum has been published for this issue. To view the erratum, please click here.

Morbidity and Mortality Weekly Report

Weekly / Vol. 61 / Nos. 51 & 52

January 4, 2013

Drowsy Driving 19 States and the District of Columbia, 20092010

According to the National Highway Traffic Safety
Administration (NHTSA), 2.5% of fatal motor vehicle crashes
(approximately 730 in 2009) and 2.0% of all crashes with nonfatal injuries (approximately 30,000 in 2009) involve drowsy
driving (1). However, although data collection methods make
it challenging to estimate the number of crashes that involve
drowsy drivers, some modeling studies have estimated that
15% to 33% of fatal crashes might involve drowsy drivers
(2,3). Fatalities and injuries are more likely in motor vehicle
crashes that involve drowsy driving compared with non-drowsy
driving crashes (1,4). To assess the state-level self-reported
prevalence of falling asleep while driving, CDC analyzed data
from a set of questions about insufficient sleep administered
through the Behavioral Risk Factor Surveillance System
(BRFSS) during 20092010. Among 147,076 respondents in
19 states and the District of Columbia (DC),* 4.2% reported
having fallen asleep while driving at least one time during the
previous 30 days. Reports of falling asleep while driving were
more common among adults who reported usually sleeping 6
hours per day, snoring, or unintentionally falling asleep during
the day compared with other adults who did not report these
characteristics. Drivers should avoid driving while drowsy and
learn the warning signs of drowsy driving.
BRFSS is a state-based, random-digitdialed telephone
survey of noninstitutionalized adults aged 18 years that is
administered by state health departments each year in collaboration with CDC. Based on Council of American Survey and
Research Organizations (CASRO) guidelines, response rates
for the states that used the optional sleep questions during
* Arkansas (2010), California (2009, 2010), Connecticut (2010), Delaware
(2010), Georgia (2009), Hawaii (2009, 2010), Illinois (2009), Kansas (2009,
2010), Louisiana (2009), Maryland (2009, 2010), Michigan (2010), Minnesota
(2009, 2010), Missouri (2010), Nebraska (2009, 2010), Nevada (2010), New
York (2009), Oregon (2010), Texas (2009), and Wyoming (2009). DC used
the module in 2010.
The percentage of persons who completed interviews among all eligible persons,
including those potential respondents for whom eligibility was not established.

20092010 had a median of 52.1% and ranged from 39.1%

(Oregon in 2010) to 68.8% (Nebraska in 2010).
Respondents were asked, During the past 30 days, have you
ever nodded off or fallen asleep, even just for a brief moment,
while driving? Drowsy driving was defined as those with an
affirmative response, whereas no drowsy driving included those
who responded no, dont drive, dont have a license, or
dont know/not sure. Respondents also were asked, On
average, how many hours of sleep do you get in a 24-hour
period? Do you snore? During the past 30 days, for about
how many days have you felt you did not get enough rest or
sleep? and During the past 30 days, for about how many
days did you find yourself unintentionally falling asleep during the day? Age-adjusted prevalence of falling asleep while
driving and 95% confidence intervals (CIs) were calculated
by state, and by selected sociodemographic and other sleeprelated characteristics. For comparisons of prevalence between
subgroups, statistical significance (p<0.05) was determined by
using t-tests. All indicated differences between subgroups are
statistically significant.
INSIDE
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1048 Notes from the Field: Serogroup C Invasive
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Sex With Men New York City, 20102012
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U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

Morbidity and Mortality Weekly Report

Among 147,076 respondents, 4.2% (unadjusted prevalence

= 4.1%) reported having fallen asleep while driving during the
previous 30 days (Table 1). Men were more likely to report
drowsy driving than women (5.3% versus 3.2%). Drowsy
driving prevalence decreased with age, from >4.9% among
adults aged 1844 years to 1.7% among those aged 65 years.
Non-Hispanic whites were less likely to report drowsy driving
than other racial/ethnic groups (3.2% versus 6.1% for nonHispanic blacks, 5.9% for Hispanics, and 6.0% for persons
of other race/ethnicity). Retired respondents (1.0%), students
or homemakers (2.1%), and unemployed respondents (3.1%)
were less likely to report drowsy driving than those who were
employed (5.1%) or unable to work (6.1%). Educational
attainment was not associated with drowsy driving. Among the
states that used the sleep module, drowsy driving prevalence
ranged from 2.5% in Oregon to 6.1% in Texas.
Drowsy driving was associated with other sleep-related characteristics. Adults who reported frequent insufficient sleep, a
daily sleep duration of 6 hours, snoring, or unintentionally
falling asleep during the day reported drowsy driving more
frequently than those who did not report those characteristics
(Table 2). Short sleep duration (6 hours) and snoring, suggestive of obstructive sleep apnea, each were related independently
to drowsy driving (Figure).

Health, National Center for Chronic Disease Prevention and

Health Promotion; Douglas R. Roehler, MPH, Div of
Unintentional Injury Prevention, National Center for Injury
Prevention and Control, CDC. Corresponding contributor:
Anne G. Wheaton, awheaton@cdc.gov, 770-488-5362.

Reported by

Available at http://books.nap.edu/catalog.php?record_id=11617.
Information available at http://www.healthypeople.gov/2020/topicsobjectives2020/

Anne G. Wheaton, PhD, Daniel P. Chapman, PhD, Letitia R.

Presley-Cantrell, PhD, Janet B. Croft, PhD, Div of Population

Editorial Note

In 2006, the Institute of Medicine released a report emphasizing the public health importance of sleep and including a
discussion of drowsy driving. As a result of increased attention
to the consequences of insufficient sleep, Healthy People 2020
added a set of sleep health objectives, including one to reduce
the rate of motor vehicle crashes caused by drowsy driving.
Previous surveys have addressed the topic of drowsy driving,
but this report presents the findings from the largest number
of U.S. survey respondents to date. The finding that 4% of
respondents reported falling asleep while driving during the
previous month agrees with previous smaller studies. In a survey
of 4,010 drivers sponsored by NHTSA, 4.2% reported falling
asleep while driving during the past month, and 11% reported
this experience in the past year (5). The corresponding results
from a survey of 2,000 U.S. residents sponsored by the AAA
Foundation for Traffic Safety in 2010 were identical (4% and
11%) (3).

objectiveslist.aspx?topicid=38.

The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
U.S. Department of Health and Human Services, Atlanta, GA 30333.
Suggested citation: Centers for Disease Control and Prevention. [Article title]. MMWR 2013;61:[inclusive page numbers].

Centers for Disease Control and Prevention

Thomas R. Frieden, MD, MPH, Director

Harold W. Jaffe, MD, MA, Associate Director for Science
James W. Stephens, PhD, Director, Office of Science Quality
Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services
Stephanie Zaza, MD, MPH, Director, Epidemiology and Analysis Program Office

MMWR Editorial and Production Staff

Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series

Maureen A. Leahy, Julia C. Martinroe,
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Information Technology Specialists

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William L. Roper, MD, MPH, Chapel Hill, NC, Chairman

Matthew L. Boulton, MD, MPH, Ann Arbor, MI
Dennis G. Maki, MD, Madison, WI
Virginia A. Caine, MD, Indianapolis, IN
Patricia Quinlisk, MD, MPH, Des Moines, IA
Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA
Patrick L. Remington, MD, MPH, Madison, WI
David W. Fleming, MD, Seattle, WA
John V. Rullan, MD, MPH, San Juan, PR
William E. Halperin, MD, DrPH, MPH, Newark, NJ
William Schaffner, MD, Nashville, TN
King K. Holmes, MD, PhD, Seattle, WA
Dixie E. Snider, MD, MPH, Atlanta, GA
Deborah Holtzman, PhD, Atlanta, GA
John W. Ward, MD, Atlanta, GA
Timothy F. Jones, MD, Nashville, TN

1034

MMWR / January 4, 2013 / Vol. 61 / Nos. 51 & 52

Morbidity and Mortality Weekly Report

TABLE 1. Age-adjusted* prevalence of falling asleep while driving during the preceding
30 days, by selected demographic characteristics and state Behavioral Risk Factor
Surveillance System, 19 states and the District of Columbia, 20092010

Characteristic
Total
Sex
Men
Women
Age group (yrs)
1824
2534
3544
4554
5564
65
Race/Ethnicity
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other, non-Hispanic
Education Level
<High school diploma or GED
High school diploma or GED
At least some college
Employment status
Employed
Unemployed
Retired
Unable to work
Student/Homemaker
State
Arkansas
California
Connecticut
Delaware
District of Columbia
Georgia
Hawaii
Illinois
Kansas
Louisiana
Maryland
Michigan
Minnesota
Missouri
Nebraska
Nevada
New York
Oregon
Texas
Wyoming
Median (range)

No. who
reported falling
asleep while
driving

(95% CI)

147,076

4,301

4.2

(3.94.6)

56,321
90,755

2,181
2,120

5.3
3.2

(4.75.9)
(2.93.5)

4,361
12,200
20,231
29,362
33,054
47,868

192
583
881
1,025
865
755

4.9
6.3
5.5
3.5
2.6
1.7

(3.86.2)
(5.17.7)
(4.86.3)
(3.14.0)
(2.22.9)
(1.51.9)

110,539
11,700
10,104
13,459

2,638
516
506
605

3.2
6.1
5.9
6.0

(2.93.5)
(5.17.4)
(5.16.8)
(4.38.3)

11,906
40,637
94,069

374
1,131
2,782

4.8
4.0
4.2

(4.05.8)
(3.54.6)
(3.84.7)

75,010
8,237
42,262
8,024
12,951

2,978
226
591
257
225

5.1
3.1
1.0
6.1
2.1

(4.75.6)
(2.44.0)
(0.51.7)
(4.09.3)
(1.62.7)

3,800
17,608
6,409
4,155
3,600
5,466
12,601
5,555
12,912
8,531
8,281
5,768
14,135
5,137
10,208
3,665
3,162
5,007
5,357
5,719

118
601
147
101
85
188
535
129
330
272
261
154
344
125
286
82
92
86
198
167

3.9
4.8
3.0
2.8
2.6
4.1
5.7
2.9
2.9
3.8
4.4
3.5
3.1
3.3
2.9
3.0
3.6
2.5
6.1
3.9
3.4

(2.95.3)
(4.35.4)
(2.24.0)
(2.03.8)
(2.03.3)
(3.25.1)
(5.16.5)
(2.33.7)
(2.53.4)
(3.24.5)
(3.75.4)
(2.84.5)
(2.63.7)
(2.44.5)
(2.43.6)
(2.14.2)
(2.74.7)
(1.83.3)
(4.68.2)
(3.14.9)
(2.56.1)

No.

Abbreviations: CI = confidence interval; GED = General Educational Development certificate.

* Age adjusted to the 2000 projected U.S. population.
The sleep module was used by California, Georgia, Hawaii, Illinois, Kansas, Louisiana, Maryland, Minnesota,
Nebraska, New York, Texas, and Wyoming in 2009, and by Arkansas, California, Connecticut, Delaware,
District of Columbia, Hawaii, Kansas, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, and
Oregon in 2010.
Unweighted sample. Categories might not sum to survey total because of missing responses.
Asian, Native Hawaiian or Pacific Islander, American Indian/Alaska Native, and multiracial.

Although it is clear that falling asleep while

driving is dangerous, drowsiness impairs
driving skills even if drivers manage to stay
awake. Drowsiness slows reaction time, makes
drivers less attentive, and impairs decisionmaking skills (6), all of which can contribute
to motor vehicle crashes. Sleep-related crashes
are more likely to happen at night or during
the midafternoon, when drivers are more
likely to be sleepy (4,7). These crashes often
involve a single vehicle going off the road,
with no evidence of braking or other attempt
to prevent the crash (4). But sleep-related
crashes also make up a disproportionate portion of rear-end and head-on collisions (7).
Importantly, drowsy driving crashes are more
likely to result in injuries and fatalities than
non-drowsy driving crashes (4).
The findings in this report are subject to
at least four limitations. First, only data from
households with landline telephones were analyzed. Second, estimates of falling asleep while
driving are based on self-report, likely resulting in
underestimates. Previous studies have shown that
persons often are not aware that they have fallen
asleep (8). Third, data were not collected for all
states and might not be generalizable to the rest
of the United States. In addition, response rates
for the states that used the optional sleep module
during 20092010 were relatively low, ranging
from 39.1% to 68.8% (median: 52.1%). Finally,
BRFSS does not survey persons aged <18 years,
thereby excluding young drivers, who might be
at increased risk for drowsy driving (4).
The best way to prevent drowsy driving is
to recognize and address the conditions that
lead to sleepiness. Those at increased risk for
drowsy driving include commercial drivers,
persons who work at night or long shifts,
drivers with untreated sleep disorders, drivers
who use sedating medications, and anyone
who does not get adequate sleep (9). Drivers
should ensure that they get enough sleep
(79 hours), seek treatment for sleep disorders,
and refrain from alcohol use before driving.
In their guide for employers of shift workers
(i.e., anyone who works beyond the typical
workday, including night shift, rotating shift,
or long shift workers), NHTSA suggests that

MMWR / January 4, 2013 / Vol. 61 / Nos. 51 & 52

1035

Morbidity and Mortality Weekly Report

Drowsy driving is an important contributor to motor vehicle

crashes and fatalities. Techniques to stay awake while driving,
such as turning up the radio, opening the window, and turning
up the air conditioner, have not been found to be effective.
Warning signs of drowsy driving include frequent yawning or
blinking, difficulty remembering the past few miles driven,
missing exits, drifting from ones lane, or hitting a rumble strip.
What is added by this report?
Overall prevalence of self-reported falling asleep while driving
during the previous 30 days was 4.2%. State-level prevalence
ranged from 2.5% in Oregon to 6.1% in Texas. Persons who
reported snoring or usually sleeping 6 hours per day were
more likely to report falling asleep while driving.
What are the implications for public health practice?
Improved surveillance and more research will be needed to
improve sleep health among U.S. adults and reduce the
prevalence drowsy driving. Public health workers should
educate themselves and their communities on the substantial
impact that insufficient sleep and sleep disorders have on the
ability to drive safely. Physicians can advise patients on lifestyle
changes to improve sleep and refer patients with more serious
sleep problems to a sleep specialist.

employers consider providing alternate transportation home

for employees or allowing naps at work.** However, once on
the road, it is also important to recognize the symptoms of
drowsiness and act appropriately, by pulling over to rest until
fully rested or by changing drivers. Techniques to stay awake
while driving, such as turning up the radio, opening the window, and turning up the air conditioner, have not been found
to be effective (10). Warning signs of drowsy driving include
frequent yawning or blinking, difficulty remembering the
past few miles driven, missing exits, drifting from ones lane,
or hitting a rumble strip. The only safe thing for drivers
to do if they start to feel tired while driving is to get off the
road and rest until no longer drowsy. In addition, continued
research into and development of improved drowsy driving
countermeasures is warranted, as outlined in a report from the
National Center on Sleep Disorders Research/NHTSA Expert
Panel on Driver Fatigue and Sleepiness. Better methods to
estimate the number of crashes caused by drowsy driving will
improve surveillance for this problem and increase the capacity
to identify effective interventions.
** Available at http://www.nhtsa.gov/people/injury/drowsy_driving1/human/
drows_driving/resource/resource.html.
Information available at http://drowsydriving.org/about/warning-signs.
Available at http://www.nhtsa.gov/people/injury/drowsy_driving1/drowsy.html.

1036

MMWR / January 4, 2013 / Vol. 61 / Nos. 51 & 52

TABLE 2. Age-adjusted* prevalence of falling asleep while driving

during the preceding 30 days, by selected sleep-related characteristics
Behavioral Risk Factor Surveillance System, 19 states and the
District of Columbia, 20092010

No.

Characteristic

Frequent insufficient sleep

(14 days of insufficient rest or
sleep during preceding 30 days)
Yes
34,114
No
112,737
Average sleep duration (hrs)
6
46,427
79
93,301
10
6,015
Snoring
Yes
71,597
No
75,437
Unintentionally fell asleep
during the day (1 day during
preceding 30 days)
Yes
52,603
No
94,344

No. who
reported falling
asleep while
driving
%

(95% CI)

1,866
2,432

6.8
3.2

(6.27.4)
(2.93.7)

2,256
1,866
137

6.7
2.6
3.9

(6.17.5)
(2.32.9)
(2.56.0)

2,571
1,728

5.6
3.2

(5.16.2)
(2.83.6)

3,016
1,278

8.6
1.8

(7.99.5)
(1.52.0)

Abbreviation: CI = confidence interval.

* Age adjusted to the 2000 projected U.S. population.
The sleep module was used by California, Georgia, Hawaii, Illinois, Kansas,
Louisiana, Maryland, Minnesota, Nebraska, New York, Texas, and Wyoming in
2009, and by Arkansas, California, Connecticut, Delaware, District of Columbia,
Hawaii, Kansas, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada,
and Oregon in 2010.
Unweighted sample. Categories might not sum to survey total because of
missing responses.

FIGURE. Age-adjusted* prevalence of falling asleep while driving

during the preceding 30 days, by usual sleep duration and snoring
Behavioral Risk Factor Surveillance System, 19 states and the
District of Columbia, 20092010
12
10

Prevalence (%)

What is already known on this topic?

Snoring
Yes
No

8
6
4
2
0
6

79

Sleep duration (hrs)

* Age adjusted to the 2000 projected U.S. population.
95% confidence interval.
Estimates for sleep duration 10 hours were not reliable because of small cell
size; relative standard error >0.3.

Morbidity and Mortality Weekly Report

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